Healthcare Provider Details

I. General information

NPI: 1093283426
Provider Name (Legal Business Name): SARAH WAGER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2018
Last Update Date: 11/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE STE 100
LONG BEACH CA
90804-2182
US

IV. Provider business mailing address

215 QUINCY AVE APT 7
LONG BEACH CA
90803-1630
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-6500
  • Fax:
Mailing address:
  • Phone: 951-204-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: